Synthetic Mesh Research Articles

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer.

Urinary incontinence is a common presentation in general practice and can significantly affect a patient's quality of life. Stress urinary incontinence (SUI) is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (egsporting activities), or on sneezing or coughing'. There is a key role for primary care providers in the assessment and management of female SUI. To highlight the key diagnostic and management principles of female SUIingeneral practice and discuss management options. SUI can usually be diagnosed based upon clinical history and targeted physical examination. Pelvic floor physiotherapy and lifestyle interventions, including weight modification and management of co-morbidities, are important first-line therapies. Surgical options for both persistent or complex SUI include urethral bulking agents, Burch colposuspension and pubovaginal fascial slings. Synthetic (mesh) mid-urethral slings remain a viable surgical option for women suffering SUI.

IS SYNTHETIC MESHPLASTY THE ONLY METHODFOR INGUINAL HERNIA REPAIR OR ARE THERE OTHER RESOURCEFUL ALTERNATIVES?

There aremultifactorial causes for development ofinguinal hernia.Weakness in the fascia transversalisplays a major role in causing a inguinal hernia. There are different techniques of repair of the inguinal hernia that are currently being practiced. Traditionally, inguinal hernia repair included usage of autogenous tissue (Shouldice, Bassini, Coopers). But the use of synthetic mesh for the repair of inguinal hernia had decreased the recurrence rate. Gradually, the complications associated with the use of synthetic mesh like infections, adhesions, granulomas, fistulae, migrations, etcbecame challenging to deal with. To avoid such complications and to overcome these challenges, we will be using autologous biological tissue i.e, an expanded sac for the repair of inguinal herniain this study.

Transobturator vaginal wall sling (Elgamasy technique) for the treatment of female stress urinary incontinence: a pilot study

BackgroundStress urinary incontinence (SUI) is a common social problem that affect about 4–35% of adult women adult. There are multiple surgical options for treatment of SUI but midurethral slings are the most effective and durable form of treatment. In this study, transobturator vaginal sling (TOT-VS, Elgamasy technique) was used to overcome the unique risks associated with synthetic mesh placement, as well as the higher rate of voiding dysfunction and harvest site complications associated with pubovaginal sling placement.Objective To assess the short-term outcome of transobturator vaginal wall sling (TOT-VS) for the treatment of SUI.Materials and MethodsThis is a prospective study included 20 females who underwent TOT-VS placement for SUI from January 2021 to March 2022 at Tanta Urology Department–Tanta University Hospitals. Two-parallel longitudinal vaginal mucosal incisions were performed 2 cm below the bladder neck, and 6 × 2 cm graft was harvested from the anterior vaginal wall, with a prolene suture on each side and fixed around the urethra via the transobturator rout. Patients were followed in the outpatient clinic after one week, two weeks, 3, 6 months and one year postoperatively. Outcomes were measured subjectively by the Bristol Female Lower Urinary Tract Symptoms (B-FLUTS) score comparing preoperative and postoperative scores and objectively by cough stress test.ResultsThe median age of patients was 42 years, and the median BMI was 30.0 kg/m2. The technique was performed, and the patient was discharged the next day after surgery. Mean operative time was 50.5 ± 9 min. All patients completed B-FLUTS at the last follow-up. Compared to preoperative scores, all patients showed significant improvement in all domains. Nineteen cases (95%) showed negative cough stress test 6 months postoperatively, and none of them suffered from severe (Clavien III-V) complications or required reoperation to release the sling. The procedure was failed in one case (5%). At one-year follow-up, no recurrence of SUI was recorded in any case.ConclusionIn the treatment of female stress urinary incontinence, transobturator vaginal wall slings can be a viable, autologous and cost-effective option with excellent short-term outcome, no recurrence, short operative periods, minor complications and short hospital stays.

Inverse primitive path analysis

The primitive-path analysis (PPA) [R. Everaers et al. Science 303, 823, (2004)] is an algorithm that transforms a model polymer melt into its topologically equivalent mesh by removing excess contour length stored in thermal fluctuations. Here we present an inverse PPA algorithm (iPPA) that gradually reintroduces contour length in a PPA mesh. We validate the method preserves topology by performing 100 cycles of PPA-iPPA transformations on a ring polymer melt. We show how a parametric curve can be used as a synthetic mesh to generate model materials of rings with entanglements forming a regular 2D cubic lattice. This shows how iPPA can be used to generate model polymer materials with well controlled topology. Finally we show how PPA-iPPA can be used to accelerate stress relaxation approximately by an order of magnitude in simulation time. This reduces the computational cost of computational studies of structure-property relations for polymer materials.

To mesh or not mesh "apical prolapse," that is the question!

The management of pelvic organ prolapse (POP) involves both nonsurgical and surgical management. Views on best surgical approach for apical prolapse is an evolving field based on recent evidence and events related to transvaginal mesh. At the 97th Annual Meeting of the North Central Section of the American Urological Association (Scottsdale, AZ, USA), this topic was discussed and debated. The following article summarizes the concepts presented that day as well as the interactive debate with three perspectives on apical prolapse surgeries. The authors were asked to support their approach in various scenarios including: extremes of age, prior hysterectomy and intact uterus, desire to avoid mesh, sexual activity, and presence of comorbidities. Surgical approaches for POP have evolved and is a popular topic for debate, particularly when discussing apical prolapse. Transvaginal native tissue repairs remain the mainstay of POP surgeries; however, transabdominal approaches continue to evolve. Use of interposition material, such as synthetic polypropylene mesh, is the standard when performing an abdominal sacrocolpopexy, however, use of autologous fascia can be considered. Small series have demonstrated the safety and efficacy of autologous fascia-based repairs; however, larger studies with longer follow-up are needed. There are a variety of surgical strategies to repair POP. Ultimate decision making on specific surgeries should be determined by patient preference and goals after appropriate counseling on all options.

Effect of lower urinary tract conditions on surgical outcomes of different suburethral sling procedures for female stress urinary incontinence.

The suburethral sling procedure has been widely used as the first-line treatment for female stress urinary incontinence (SUI). This study retrospectively compared the long-term surgical outcomes and complications between retropubic and transobturator suburethral sling procedures. From 2010 to 2022, a total of 533 women with SUI underwent retropubic pubovaginal sling (PVS) or transobturator tape (TOT) procedures using a synthetic polypropylene mesh with or without concomitant anterior colporrhaphy. All patients underwent preoperative videourodynamic studies, Valsalva leak point pressure (VLPP), and voiding efficiency (VE). The success rate, postoperative complications, overactive bladder symptoms, transvaginal urethrolysis, and repeat procedures were compared among different surgical procedures. Among the patients, PVS was performed in 251 (47.1%) patients and with colporrhaphy in 58 (10.9%), TOT in 174 (32.6%) and with colporrhaphy in 50 (9.4%). The success rate was 87.4% in the PVS group and 75.4% in the TOT group, with or without colporrhaphy (p = 0.001). Urethrolysis was performed in 4.7% of the patients, and repeat suburethral sling procedures were performed in 8.3%. The overall success rate was significantly lower in TOT group, either with high or low VLPP, or with high or low VE. The rate of persistent OAB was significantly higher in TOT group regardless of VLPP or VE, whereas patients with VE < 90% at baseline had a significantly higher rate of postoperative dysuria. TOT procedures had an inferior long-term success rate than PVS procedures for female SUI. Additionally, no differences in the success rate were observed between patients with different bladder functions, high or low VLPP, and high or low VE.

A Comparison of Capsular Contracture Rates after Implant-Based Breast Reconstruction Using ADM Versus Synthetic Mesh

Abstract Goals/Purpose Capsular contracture is a local complication in which there is tightening of the capsule around the implant. This complication has been shown to occur in 15-30% of implant-based breast reconstruction patients and often requires revision surgery for correction. Prior investigations have suggested that the use of ADM can reduce the risk for development of capsular contracture, with more recent research suggesting that synthetic mesh may provide the same benefit. Several meta-analyses have attempted to compare ADM and mesh use for the prevention of capsular contracture, but they all emphasize the continued need for clinical investigation with direct comparisons. The goal of this study is to assess our own reconstruction patient population to compare capsular contracture rates between ADM and mesh cohorts, as well as to assess for other potential risks that may increase the rate of capsular contracture in these patients. Methods/Technique A 15-year retrospective review of all implant-based breast reconstructions performed by the senior author was performed. All operations occurred between 2008 and 2023 in a hospital setting. Patient demographics were assessed including age, BMI, implant size, radiation history, location of malposition, and use of either ADM or mesh. Post-operative complications including incidence of capsular contracture were recorded. Patients who had documented capsular contracture prior to scaffold insertion were excluded from the study. Wilcoxon signed rank test, 2-sided t-test, and Fischer’s Exact test were used to compare baseline demographics and capsular contracture rates between the two groups, along with a multivariate logistic regression analysis to control for potential confounders. Results/Complications Fifty-two breasts underwent capsulorraphy, of which 25 (48.1%) used ADM and 27 (51.9%) used mesh. Average age was 50.6 years, average BMI was 27.7, average implant size was 541.8 cc, and eight breasts (15.4%) had been irradiated. Average follow-up time was seven years (mean = 85.4 months, range 22 – 149 months, SD = 35.9). Fourteen (26.9%) capsulorraphies were for inferior malposition, 13 (25.0%) for lateral malposition, and 25 (48.1%) were for inferolateral malposition. Patients in the ADM group had significantly more lateral malposition prior to insertion as compared to the mesh group which had more inferior malposition (p=0.0246). There was no significant difference between the two groups for any other recorded baseline demographic; these demographics included age, BMI, hypertension, diabetes, history of tobacco use, radiation, chemotherapy, implant volume, and implant surface texture. Capsular contracture occurred in 2 ADM breasts (8.0%) and 4 mesh breasts (14.8%) with no significant difference between the two groups (p=0.6695). Five of these capsular contractures had documented Baker grades with three grade II, one grade III, and one grade IV. None of the recorded baseline demographics significantly increased the risk for capsular contracture development. Conclusion ADM and synthetic mesh both function as effective tools for reducing the risk of developing capsular contracture after prosthetic breast reconstruction. The rate of capsular contracture with ADM was only 8.0% and the rate with mesh was only 14.8%. Both rates are lower than the 15-30% incidence that has been found in breast reconstruction patients without mesh. None of the patient demographics were significant risk factors for capsular contracture development, so these are unlikely to be confounders. There was no significant difference in rate of capsular contracture between the two groups, suggesting that ADM and mesh are similarly efficacious at preventing capsular contracture in reconstruction patients.

Use of autologous pericardial patch graft for treatment of large congenital peritoneopericardial diaphragmatic hernia in two cats

AbstractPeritoneopericardial diaphragmatic hernia is a congenital structural anomaly that results in a communication between the pericardial sac and the peritoneal cavity. About 50% of cats are asymptomatic at the time of diagnosis, and the remaining animals may show respiratory (dyspnoea, tachypnoea, exercise intolerance), gastrointestinal, cardiac tamponade or non‐specific clinical signs. Median celiotomy for herniorrhaphy without tension (primary closure, muscle flaps, synthetic mesh, pericardium) is the treatment of choice for symptomatic patients. Two cats were referred with respiratory signs, secondary to a peritoneopericardial diaphragmatic hernia. A pericardial patch graft was obtained and sutured to the diaphragm as an alternative technique to close the large defect and not cause excessive tension on the diaphragm and caval foramen. Patients recovered well without any complications after surgery. Re‐examination and thoracic radiographs at 1 week, 2 weeks, 3 months, 6 months and 3 years postoperatively showed no signs of recurrence and the patients remained asymptomatic.

Evaluation of 30-day outcomes for open ventral hernia repair using self-gripping versus nonself-gripping mesh.

The use of mesh is standard of care for large ventral hernias repaired on an elective basis. The most used type of mesh includes synthetic polypropylene mesh; however, there has been an increase in the usage of a new polyester self-gripping mesh, and there are limited data regarding its efficacy for ventral hernia. The purpose of the study is to determine whether there is a difference in surgical site occurrence (SSO), surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), and recurrence at 30 days after ventral hernia repair (VHR) using self-gripping (SGM) versus non-self-gripping mesh (NSGM). We performed a retrospective study from January 2014 to April 2022 using the Abdominal Core Health Quality Collaborative (ACHQC). We collected data on patients over 18 years of age who underwent elective open VHR using SGM or NSGM and whom had 30-day follow-up. Propensity matching was utilized to control for variables including hernia width, body mass index, age, ASA, and mesh location. Data were analyzed to identify differences in SSO, SSI, SSOPI, and recurrence at 30 days. 9038 patients were identified. After propensity matching, 1766 patients were included in the study population. Patients with SGM had similar demographic and clinical characteristics compared to NSGM. The mean hernia width to mesh width ratio was 8cm:18cm with NSGM and 7cm:15cm with SGM (p = 0.63). There was no difference in 30-day rates of recurrence, SSI or SSO. The rate of SSOPI was also found to be 5.4% in the nonself-gripping group compared to 3.1% in the self-gripping mesh group (p < .005). There was no difference in patient-reported outcomes at 30 days. In patients undergoing ventral hernia repair with mesh, self-gripping mesh is a safe type of mesh to use. Use of self-gripping mesh may be associated with lower rates of SSOPI when compared to nonself-gripping mesh.

Open repair of flank and lumbar hernias: 142 consecutive repairs at a high-volume hernia center

BackgroundFlank and lumbar hernias (FLH) are challenging to repair. This study aimed to establish a reproducible management strategy and analyze elective flank and lumbar repair (FLHR) outcomes from a single institution. MethodsA prospective analysis using a hernia-specific database was performed examining patients undergoing open FLHR between 2004 and 2021. Variables included patient demographics and operative characteristics. ResultsOf 142 patients, 106 presented with flank hernias, and 36 with lumbar hernias. Patients, primarily ASA Class 2 or 3, exhibited a mean age of 57.0 ​± ​13.4 years and BMI of 30.2 ​± ​5.7 ​kg/m2. Repairs predominantly utilized synthetic mesh in the preperitoneal space (95.1 ​%). After 29.9 ​± ​13.1 months follow-up, wound infections occurred in 8.3 ​%; hernia recurrence was 3.5 ​%. At 6 months postoperatively, 21.2 ​% of patients reported chronic pain with two-thirds of these individuals having preoperative pain. ConclusionsOpen preperitoneal FLHR provides a durable repair with low complication and hernia recurrence rates over 2.5 years of follow-up.

The Impact of Technical Innovations and Donor-Site Mesh Repair on Autologous Abdominal-Based Breast Reconstruction-A Retrospective Analysis.

Background: The aim of this study was to examine the potential benefit that may be achieved through the introduction of technical innovations and the incorporation of mesh for fascial donor site closure in uni- and bilateral autologous breast reconstruction with abdominal tissue. Methods: A retrospective single-center review of all breast reconstructions with a DIEP or MS-TRAM flap between January 2004 and December 2019 was performed. Donor and recipient site complications and operation times were evaluated before and after the implementation of coupler anastomoses, preoperative computed tomography angiography (CTA), indocyanine green (ICG) angiography, and the inclusion of mesh in donor site repair. Results: A total of 396 patients were included, accounting for 447 flaps. Operation time was significantly shorter in unilateral reconstructions after the implementation of CTA (p < 0.0001). ICG angiography significantly reduced the rates of partial flap loss (p = 0.02) and wound healing disorders (p = 0.02). For unilateral reconstructions, abdominal bulging or hernia was observed more often in MS1-TRAM flaps without synthetic mesh repair (p = 0.001), whereas conservatively treated seroma developed more frequently after mesh implantation (p = 0.03). Conclusions: Recent technological advancements developed over the past few decades have made a substantial impact on decreasing surgical duration and enhancing procedure safety.

Harvest of large fascia lata autograft: Outcomes in 108 patients.

Due to the reclassification of transvaginal mesh as a high-risk device, there has been renewed interest in the use of fascia lata in pelvic floor reconstruction. Here we report our experience in 108 patients who underwent large fascia lata harvest for pelvic organ prolapse (POP) repair. Our primary objective was to highlight the postoperative morbidity of the large fascia lata harvest in patients who underwent POP repair using fascia lata autograft. Surgery involved harvesting a fascia lata graft through a small lateral upper thigh incision and was used for either autologous transvaginal POP repair or autologous sacrocolpopexy. To prevent seroma, a temporary Jackson-Pratt drain was intraoperatively placed and a mild compression wrap was applied to the area for 4-6 weeks postoperatively. Patient demographics were obtained preoperatively, while physical exam findings and postoperative outcomes related to the fascia lata harvest were collected at sequential follow up visits. One-hundred eight patients underwent 111 large fascia lata harvests for either transvaginal or abdominal/robotic POP repair from July 2016 to January 2022. Mean follow-up was 19.6 months (range: 1-65) with 38 patients having 24 months or more of follow-up. Mean Visual Analog Pain (VAP) score was 1 (range: 0-10). Sixteen patients developed asymptomatic thigh bulges, 16 patients developed harvest site seromas (of which 14 resolved), and 59 patients experienced mild, non-bothersome paresthesia near the incision. Large fascia lata harvest offers a robust autograft for transvaginal or transabdominal POP repair with minimal morbidity. Harvest site complications are minor and typically resolve with expectant management. This technique can be safely utilized in patients who desire graft-augmented repair of POP without the use of synthetic mesh, allograft, or xenograft.

Use of polyglactin mesh coated with platelet-rich plasma for diaphragmatic defect healing in rabbits. Protocol for a Randomised Controlled Trial

Absorbable, biosynthetic scaffolds are a promising option for repair of diaphragmatic defects, since they are associated with less mesh-related complications than non-absorbable synthetic meshes. Coating of absorbable synthetic meshes with anti-inflammatory and healing agents, such as platelet-rich plasma (PRP), is a widely studied technique for improving mesh-tissue integration and reducing recurrence rate. The aim of this study is to investigate the synergic effect of a PRP-coated synthetic absorbable polyglactin mesh 2cmx2cm in healing of a diaphragmatic defect in an experimental rabbit model. Animals will be equally randomised in the PGM-PRP group (absorbable polyglactin mesh enriched with PRP) or the PGM group (use of absorbable polyglactin mesh only). Rabbits will undergo laparotomy under general anaesthesia and resection of a portion of the diaphragmatic central tendon 1cmx1cm. Samples will be euthanised on the 91th postoperative day and samples of 3cmx3cm will be harvested. The mesh-tissue integration will be assessed based on macroscopic, microscopic, immunohistochemical and morphometric parameters. The study is indesign stage and results are expected to be available by the end of the following year. High-quality evidence is expected regarding the synergic effect of PRP and synthetic absorbable polyglactin meshes in diaphragm repair.

Hernia Recurrence and Complications After Abdominal Reconstruction With Reinforced Versus Nonreinforced Biologic Mesh.

Both biologic and permanent (synthetic) meshes are used for abdominal wall reconstruction. Biologic mesh has the advantage of eventual incorporation, which makes it generally preferred in contaminated patients compared with synthetic mesh (Ann Surg. 2013;257:991-996). However, synthetic mesh has been shown to have decreased long-term hernia recurrence despite increased complications (JAMA Surg. 2022;157:293-301). Ovitex (TelaBio, Ltd, Auckland, New Zealand) is a combined reinforced biologic mesh with a permanent Prolene suture weave that theoretically combines incorporation with a long-term strength component. We hypothesize that a reinforced biologic will have a similar complication profile but decreased long-term hernia recurrence. A single-center retrospective review was performed from January 2013 to January 2022. Baseline patient characteristics and outcomes including 90-day complications and recurrence were compared. Categorical and continuous variables were analyzed with χ2 and Wilcoxon rank sum tests, respectively. Predictors of postoperative complications and hernia recurrence were analyzed via univariate logistic regression and multivariate logistic regression with backward stepwise selection with a threshold of P < 0.2. Two hundred fifty-four patients underwent abdominal wall reconstruction biologic mesh (Strattice, Allergan; FlexHD, MTF Biologics; Alloderm, Allergan; Surgisis Gold, Cook Biotech; Ovitex, Telabio) with retrorectus (66.5%) or intraperitoneal (33.5%) mesh placement. Sixty-six of these used reinforced biologic mesh (Ovitex, TelaBio). Baseline characteristics were comparable including preoperative hernia size measured on CT. The mean follow-up time was 343 days. The majority of patients underwent component separation (80.3% bilateral, 11.4% unilateral, 8.3% none). On univariate analysis, reinforced biologic mesh did not impact 90-day complication rates (P = 0.391) or hernia recurrence rates (P = 0.349). On multivariate analysis, reinforced mesh had no impact on complication or recurrence rates (P > 0.2). A previous history of infected mesh was an independent risk factor for hernia recurrence (P = 0.019). Nonreinforced biologics were more likely to be used in instances of previous mesh infection (P = 0.025), bowel resection (P = 0.026), and concomitantly at the time of stoma takedown (P = 0.04). Reinforced biologics were more likely to be used with a history of previous hernia repair with recurrence not due to infection (P = 0.001). Body mass index >35 was an independent risk factor across both groups for 90-day complications (P = 0.028). Reinforced versus nonreinforced biologics have similar risk profile and recurrence rate when placed primary fascial repair achieved. In abdominal walls with history of infection, or abdominal wall reconstruction performed concomitantly at the time of stoma takedown or bowel resection/anastomosis, nonreinforced biologics were used more commonly with no difference in negative outcomes. This implies that they may have a role for use in contaminated surgical cases. Reinforced biologics were more commonly used as a mesh choice in the setting of previous hernia repair with recurrence with no difference in outcomes. This implies that the reinforced nature may be useful in situations where extra reinforcement of already traumatized abdominal wall tissue is needed. Retrorectus or intraperitoneal placement of any biologic mesh is acceptable and should be chosen based off surgeon comfort and anticipated cost saving of individual mesh brands. There may be a role for reinforced mesh in the setting of previous failed hernia repair with weakened fascia, as well as nonreinforced in contaminated cases.

Transplant of the Abdominal Rectus Fascia in rats, first report of a novel experimental technique

BackgroundAfter intestinal or multivisceral transplant, closing the abdominal wall can be challenging, as negative pressure dressing or synthetic meshes pose risks like infections and fistulas. Clinical practice has evolved from vascularized abdominal wall transplants to non-vascularized Abdominal Rectus Fascia (TxARF). Although it was successful, many immunological aspects remain unknown, highlighting the need for further research. MethodsThe technique was developed by reproducing the technical aspects of the procedure described for humans in rats (Wistar and Sprague Dawley). Twenty-six Isogenic and Allogeneic TxARF procedures were performed and followed until 30 and 120 post-transplant days (PTD). The non-implanted fascias served as a control group. Rats were then re-assessed for engraftment on 7, 11, 30 and 120 PTD. Fascia samples were taken to assess neovascularization by quantifying cell composition and blood vessels using H&E and Orcein staining. ResultsAll animals (N=26) survived at 30 and 120 PTD, with 4 (15.4 %) developed subcutaneous serum collection. Upon reoperation, grafts showed neovascularization. No adhesions were observed between the intestines and the grafts. The principal cell compound of the fascia was represented by Fibroblasts (18.35 cells/field) and Myocytes (6.57 cells/field). A significant increment of the number of blood vessels were observed during the period studied (p=0.046). ConclusionsOur report on TxARF in rats, proves the feasibility of this experimental and translational model, showing similar results to those published in the clinical field. Further studies are required to evaluate the immunogenicity as well as the changes in ARF overtime.

Mesh vs. non-mesh repair of type I hiatal hernias: a propensity-score matching analysis of 6533 patients from the Herniamed registry

IntroductionSurgical treatment of type I hiatal sliding hernias aims to control the gastroesophageal reflux symptoms and prevention of hernia recurrence. Usually, a cruroplasty is performed to narrow the hiatal orifice. Here, it remains controversial if a mesh reinforcement of the cruroplasty should be performed, since benefits as well as mesh-associated complications have been described.MethodsWe performed a propensity-score matching analysis with data derived from the Herniamed registry comparing patients undergoing laparoscopic type I hiatal hernia repair with and without synthetic mesh. We analyzed perioperative, intraoperative, and postoperative data including data derived from the 1-year follow-up in the registry.Results6.533 patients with an axial, type I hiatal hernia and gastroesophageal reflux are included in this analysis. Mesh augmentation of the hiatoplasty was performed in n = 1.252/6.533 (19.2%) of patients. The defect size in the subgroup of patients with mesh augmentation was with mean 16.3 cm2 [14.5; 18.2] significantly larger as in the subgroups without mesh augmentation with 10.8 cm2 [8.7; 12.9]; (p < 0.001). In patients with mesh hiatoplasty n = 479 (38.3%) Nissen and n = 773 (61.7%) Toupet fundoplications are performed. 1.207 matched pairs could be analyzed. The mean defect size after matching was with 15.9 cm2 comparable in both groups. A significant association was seen regarding recurrence (4.72% mesh vs. 7.29% non-mesh hiatoplasty, p = 0.012). The same relation can be seen for pain on exertion (8.78% vs 12.10%; p = 0.014) and pain requiring treatment (6.13% vs 9.11%; p = 0.010). All other outcome parameter showed no significant correlation.ConclusionsOur data demonstrate that mesh-reinforced laparoscopic type I hiatal hernia repair in larger defects is associated with significantly lower rates for recurrence, pain on exertion and pain requiring treatment.

A comparison of patient-reported outcomes in patients undergoing abdominal wall repair with either synthetic or biosynthetic mesh: a pilot study.

Repair of midline ventral incisional hernias (VIHR) requires mesh reinforcement. Mesh types can be categorised into synthetic, biosynthetic, or biological. There is a lack of evidence to support one type of mesh over another. The aim of this pilot study was to compare mesh sensation in patients having undergone elective open repair with synthetic or biosynthetic mesh. Four years of prospectively collected data were retrospectively reviewed on 40 patients who had undergone VIHR, using either biosynthetic or synthetic mesh placed in the retromuscular plane. The decision on type of mesh used was governed by patient characteristics. Patients were invited to complete the Carolinas Comfort Scale (CCS) questionnaire, the higher the score indicating a poorer quality of life. The maximum length of follow-up was 36months. Twenty patients received permanent synthetic and 20 biosynthetic mesh. There was no clinical evidence of hernia recurrence in either group in the short to medium term. Overall, 97% (39/40) patients reported an average of either no or mild symptoms (mean CCS score 17.9 of 115). Patients with a biosynthetic repair had a significant lower CCS at ≥ 18months (p < 0.05). After VIHR, patients have low CCS scores, indicating good quality of life outcomes, in the short to medium term irrespective of the mesh used. However, biosynthetic mesh had lower CCS scores in the medium term. This may help surgeons and patients make better informed decisions about which mesh to use in their individual circumstances.

Open transversus abdominis release in incisional hernia repair: technical limits and solutions.

Incisional hernias with a defect width of more than10cm are considered complex. The European Hernia Society guidelines recommend that such hernias should only be repaired by surgeons with experience of component separation. The standard component separation technique now is posterior component separation with transversus abdominis release (PCSTAR). Questions are raised about the limits of this technique. A literature search of publications on PCSTAR was performed for any references to the limits of this technique in open incisional hernia repair. We found 26 publications relevant to answer this research questions. The standard PCSTAR can generally be used for a defect width of up to 15-17cm. For defects greater than 17cm problems must be expected with procedural tasks involving closure of the posterior layer and anterior fascia. No data are available in the literature on the bridging rate for the posterior layer. However, our own experiences show that gaps (holes) occur in the very thin peritoneum/fascia transversalis during dissection and these must be carefully closed. Furthermore, bridging with an absorbable synthetic mesh is needed not so rarely. Closure of the anterior fascia is successful in 81.0-97.2% of cases. In addition to a further mesh for anterior fascial closure, the hernia sac bound with multiple, accordion-like stitches can also be used. For a defect width greater than 17cm, the limits of PCSTAR become increasingly evident and can be overcome through special technical solutions for closure of the posterior layer and the anterior fascia.

Can surgeons accurately identify mesh type when interpreting computed tomography scans after ventral hernia repair?

Recurrent ventral hernia repair can be challenging due to scarred tissue planes and the increasing complexity of disease related to multiple recurrences. Given the challenges of acquiring complete and accurate prior operative reports, surgeons often rely on computed tomography (CT) scans to obtain information and plan for re-operation. Still, the contribution of CT scans and the ability of surgeons to interpret them is controversial. Previously, we examined the ability of surgeons to determine prior operative techniques based on CT scans. Here, we assessed the accuracy of expert abdominal wall reconstruction (AWR) surgeons in identifying the type of prior mesh using CT imaging. A total of 22 highly experienced AWR surgeons were asked to evaluate 21 CT scans of patients who had undergone open ventral hernia repair with bilateral transversus abdominis release utilizing mesh. The surgeons were required to identify the mesh type from a multiple-choice selection. Additionally, negative controls (patients without a history of prior laparotomy) and positive controls (patients with laparotomy but no ventral hernia repair) were incorporated. The accuracy of the surgeons and interrater reliability was calculated. The accuracy rate of the surgeons in correctly identifying the mesh type was 46%, with heavy-weight synthetic mesh (HWSM) being identified only 35.4% of the time, Strattice mesh and medium-weight synthetic mesh (MWSM) were identified at 46.3%, and 51.8%, respectively. The interrater reliability analysis found a moderate level of agreement 0.428 (95% CI 0.356-0.503), and the repeatability measure was poor-0.053 (95% CI 0-0.119); this indicates that surgeons cannot reliably replicate the identification process. Surgeons' ability to accurately identify the type of previous mesh using CT scans is poor. This study underscores the importance of documenting the type of mesh used in the operative report and the need for standardized operative notes to improve the accuracy and consistency of documentation.

Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors

Recurrence is one of the most challenging adverse events after ventral hernia repair as it impacts quality of life, utilization of resources, and subsequent need for re-repair. Rates of recurrence range from 30% to 80% after ventral hernia repair. To determine the contemporary ventral hernia recurrence rate over time in patients with previous hernia repair and to determine risk factors associated with recurrence. This retrospective, population-based study used the Abdominal Core Health Quality Collaborative registry to evaluate year-over-year recurrence rates in patients with prior ventral hernia repair between January 2012 and August 2022. Patients who underwent at least 1 prior ventral hernia repair were included and categorized into 2 groups based on mesh or no-mesh use. There were 43 960 eligible patients; after exclusion criteria (patients with concurrent inguinal hernias as the primary diagnosis, nonstandard hernia procedure categories, American Society of Anesthesiologists class unassigned, or no follow-up), 29 834 patients were analyzed in the mesh group and 5599 in the no-mesh group. Ventral hernia recurrence rates. Risk factors analyzed include age, body mass index, sex, race, insurance type, medical comorbidities, American Society of Anesthesiologists class, smoking, indication for surgery, concomitant procedure, hernia procedure type, myofascial release, fascial closure, fixation type, number of prior repairs, hernia width, hernia length, mesh width, mesh length, operative approach, prior mesh placement, prior mesh infection, mesh location, mesh type, postoperative surgical site occurrence, postoperative surgical site infection, postoperative seroma, use of drains, and reoperation. Among 29 834 patients with mesh, the mean (SD) age was 57.17 (13.36) years, and 14 331 participants (48.0%) were female. Among 5599 patients without mesh, the mean (SD) age was 51.9 (15.31) years, and 2458 participants (43.9%) were female. When comparing year-over-year hernia recurrence rates in patients with and without prior mesh repair, respectively, the Kaplan Meier analysis showed a recurrence rate of 201 cumulative events with 13 872 at risk (2.8%) vs 104 cumulative events with 1707 at risk (4.0%) at 6 months; 411 cumulative events with 4732 at risk (8.0%) vs 184 cumulative events with 427 at risk (32.6%) at 1 year; 640 cumulative events with 1518 at risk (19.7%) vs 243 cumulative events with 146 at risk (52.4%) at 2 years; 731 cumulative events with 670 at risk (29.3%) vs 258 cumulative events with 73 at risk (61.4%) at 3 years; 777 cumulative events with 337 at risk (38.5%) vs 267 cumulative events with 29 at risk (71.2%) at 4 years; and 798 cumulative events with 171 at risk (44.9%) vs 269 cumulative events with 19 at risk (73.7%) at 5 years. Higher body mass index; immunosuppressants; incisional and parastomal hernias; a robotic approach; greater hernia width; use of a biologic or resorbable synthetic mesh; and complications, such as surgical site infections and reoperation, were associated with higher odds of hernia recurrence. Conversely, greater mesh width, myofascial release, and fascial closure had lower odds of recurrence. Hernia type was the most important variable associated with recurrence. In this study, the 5-year recurrence rate after ventral hernia repair was greater than 40% and 70% in patients with and without mesh, respectively. Rates of ventral hernia recurrence increased over time, underscoring the importance of close, long-term follow up in this population.